社区儿童保健体检272 例心脏杂音结果分析

目的:初步探讨社区卫生中心针对0~6 岁散居婴幼儿及儿童保健体检对疾病尤其心脏疾病筛查的重要性，以及心脏杂音体征在0~6岁散居婴幼儿和儿童心脏疾病诊断中的重要性。方法:对2009 年7月~2013 年6 月本社区卫生服务中心所属辖区进行0~6岁散居儿童保健大体检中听诊到心脏杂音的272名婴幼儿及儿童进行专案管理登记并尽快转至上级专科医院进行心脏彩超、心肌酶等检查以明确产生心脏杂音的原因及疾病。结果:转诊的272名查体有心脏杂音的0~6岁儿童上级心血管专科医院的诊断结果为病理性杂音124例，占45.6%，生理性杂音148例，占54.4%，其中病理性杂音包括先天性心脏病85例（占31.3%），即室间隔缺损（VSD）62 例（占22.8%）、房间隔缺损（ASD）13 例（占4.8%）、房室间隔缺损（AVSD）2例（0.7%），动脉导管未闭（PDA）10 例（3.7%）；继发性心脏病37例（占13.6%），包括感染性心肌损害27 例（9.9%）、心肌炎2 例（0.7%）、感染性心内膜炎1例（0.4%），贫血性心脏病7 例（25.7%）；生理性杂音148例，包括左室假腱索42 例（15.4%）、瓣膜反流及瓣膜脱垂42例（15.4%），心脏无异常64 例（23.5%）。先天性心脏血管病<1岁年龄组所占比例显著高于1-岁组，更高于2-岁以上组（均P<0.01）。而继发性心脏病和生理性杂音<1岁组所占比例显著低于1 岁组和2 岁组（均P<0.01）。在<1岁组中先天性心脏血管病所占比例显著高于继发性心脏病和生理性杂音。结论:本社区儿童保健体检查体中对发现的异常体征如心脏杂音的婴幼儿及儿童进行及时专科转诊后发现先天性心脏病和继发性心脏病的比例较高，是引起心脏杂音的主要原因。社区卫生中心针对散居婴幼儿及儿童每年定期免费保健大体检可对散居儿童的生长发育和疾病筛查有重要意义和积极作用，认真做好基层医疗儿童保健工作可使散居儿童得到疾病的早发现、早治疗。

Results analysis of community child health examinations in 272 cases of at risk children with heart murmur

AIM:To preliminarily study the importance of health care and physical examination from the community health service center for infants and children aged 0 to 6 years old in disease screening, especially for heart disease. METHODS: Two hundred seventy-two at-risk infants and children aged 0 to 6 years old with auscultated cardiac murmur during physical examination carried out at the district belonging to the community health service center from July 2009 to June 2013 were registered for project management. Children were transferred to the superior specialized hospital for cardiac color ultrasound and myocardial enzyme examintions to identify the causes of heart murmur and the disease. RESULTS: According to the diagnostic results of the specialized cardiovascular hospital for the 272 at-risk infants and children aged 0 to 6 years old with auscultated cardiac murmur, 124 cases were pathological murmur (45.6%) and 148 (54.4%) cases were physiological murmur. In the infants and children with pathological murmur, 85 cases were diagnosed as congenital heart disease (31.3%) including 62 cases (22.8%) of ventricular septal defect (VSD), 13 cases (4.8%) of atrial septum defect (ASD), two cases (0.7%) of atrioventricular septal defect and ten cases (3.7%) of patent ductus arteriosus (PDA); 37 cases (13.6%) were secondary heart disease including 27 cases (9.9%) of infectious myocardial damage, two cases (0.7%) of myocarditis, one case (0.4%) of infectious endocarditis and seven cases (25.7%) of anemic heart disease; 148 cases were physiological murmur including 42 cases (15.4%) of left ventricular false tendons, 42 cases (15.4%) of valvular regurgitation and prolapse, and 64 cases (23.5%) with no abnormalities. The proportion of congenital heart vascular disease in the group aged <1 year was significantly higher than the group aged >1 year and even higher than the group aged >2 years (both P<0.01). The proportions of secondary heart disease and physiological murmur in the group aged <1 year was significantly lower than the groups aged >1 year and 2 years (both P<0.01). The proportion of congenital vascular heart disease in the group aged <1 year was significantly higher than the proportions of secondary heart disease and physiologic murmur. CONCLUSION: The proportions of congenital heart disease and secondary heart disease of infants and children with auscultated cardiac murmur in the physical examination for community health care were better diagnosed in the specialized referral hospital. Free and regular health care and physical examination from the community health service center for at risk infants and children every year plays an important and positive role in the child’s growth and disease screening; therefore, careful and early primary health care can reveal childhood diseases in order to obtain timely treatment.